Keeping us in the dark

“Prison can exacerbate mental health problems, which has a long-term impact on the individual concerned and the community into which he or she may be released.”

Her Majesty’s Chief Inspector of Prisons, Britain, 1996

I’ve got a new mantra for the provincial Tories as they head into a fall election: “Closed. Covert. Irresponsible.”

That’s about the only way to describe a government that pays lip service to being open, transparent and accountable and then acts in the completely opposite manner.

I’m talking about the kind of government that pretends to support citizens’ rights to access information and avail of the services of an ombudsman, then does its best to thwart those rights.

A government that sometimes has to be threatened with court action before it will turn over records that should be available to the public, or before it will concede that the citizens’ representative has the right to investigate when he receives complaints from people who say they’ve been treated unfairly.

A government that, for years, has expected inmates to put up with a rigid form of medical care that other people wouldn’t tolerate.

In rejecting citizens’ representative Barry Fleming’s report about psychiatric care at Her Majesty’s Penitentiary this week, Kathy Dunderdale’s administration was basically saying that there are citizens, and then there are second-class citizens.

Yes, there are those who would argue that the people down at The Pen are scumbags who should just put up and shut up.

Those people are ignoring the facts.

People who end up in prison often have mental health issues that are compounded and aggravated by incarceration. It is in the best interests of public safety and the public purse to see that convicts are provided the medical treatment they need to get well and reintegrate successfully back into the community once their time is served.

Ignore their mental health issues and take away their medications willy-nilly and you might as well go ahead and install a revolving door at HMP.

As one inmate noted in his complaint to the citizens’ representative after his meds were cut off in prison:

“I feel like I’m going crazy the way I’m feeling without my meds. I would not want to be released into society. There’s no point. I don’t feel normal anymore. … I’ve seen three suicide attempts in the last month. So far this year there have been two deaths and it’s getting worse. I ask you to please help me before it’s too late.”

Complaints swirling for years

Fleming’s office investigated several complaints like that one, and consulted with other psychiatrists and medical personnel.

HMP psychiatrist Dr. David Craig has long had a reputation for being conservative in his prescribing practices, and he has suggested that some inmates rely on drugs not necessarily because they are medically required, but because it helps them avoid dealing with their real problems.

While Craig’s approach may work for some, Fleming advocates that inmates be given access to the same level of health care available to members of the public, such as the right to seek a second opinion.

“Given the fact that the inmates had been prescribed these drugs prior to incarceration by physicians and psychiatrists, and then were having them reduced upon incarceration, the Department of Justice — in maintaining this policy — was not treating inmates fairly,” Fleming said.

In 1998, an editorial in the British medical journal The Lancet noted: “The principle that prisoners are entitled to the same level of health care as that provided in the wider community is accepted in enlightened societies and prison systems.”

In rejecting Fleming’s report, Collins said, “Mr. Fleming, in our estimation, does not have the expertise or the jurisdiction to comment on the professional judgment or prescription practices of a physician.”

That’s not the tune his government was singing when Fleming was appointed in October 2006.

Back then, Danny Williams said Fleming’s “professional credentials and work experience … make him an excellent candidate for this extremely important position.”

That work experience includes extensive expertise in human rights law. Surely that qualifies Fleming to investigate whether or not a group of citizens’ human rights are being infringed upon.

Office reinstated

It was Roger Grimes’ Liberal government, in 2001, that reinstated the ombudsman’s office, saying it wanted to “create a greater level of trust, openness and accountability.”

“The reinstated citizens’ representative will be totally independent of government and is free to make any recommendations necessary,” Justice Minister Kelvin Parsons said then.

No one said anything about the government being free to ignore those recommendations.

Why fund an office that isn’t allowed to carry out its work? Why even pretend to be accountable?

Why did Collins ignore the ombudsman but then bend to public opinion and order a review of Craig’s work? Too many votes at stake, perhaps?

And what was the real reason Fleming’s report was rejected? Is it that the government saves money if there are fewer prescriptions issued at HMP?

Who will be responsible if inmates die or commit suicide because they’ve been denied their medications?

Would the provincial government rather save money on pills or legal bills?

The problems down at HMP are the worst-kept secrets in town. The prescribing practices were raised as an issue in the 2008 report Decades of Darkness, Moving Towards the Light.

When the justice minister said on Wednesday that he would order a peer review of Craig’s work, he would not commit to making those findings public.

Why not make them public? Because they might support Fleming’s recommendations?

It seems this provincial government is content to operate in the dark.

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Recent comments

Jay

April 04, 2011 - 13:10

Pam - I was not discussing the citizen's report. My comment was in regards to the peer review which were the findings that the Minister would not commit to releasing. The citizen's report and the peer review are two very different documents. I listed two valid reasons why the government may need to keep some portions, or all, of the report private. Until you know the contents of the report or hos the findings are tied to specific case studies you cannot gaurantee that all of the findings will be able to be released. The Citizens Rep and the Privacy Commissioner routinely agree that some documents or portions thereof cannot be released.

The minister cannot commit to making the report public because, depending on the report method and contents, he may legally be barred from doing so. There is legislation in NL that protects the privacy of individuals. The report is likely to include private information about Dr. Craig and the inmates that may be protected legislation.
Furthermore, it is in the public's best interests to permit confidential peer reviews, doctors will be less willing to review the practices of their peers if they know that their identity and comments will become public.
If you are going to criticize a decision you should ensure you have all the facts.

Jay, there's no reason why the minister could not make the report's recommendations public and still protect private information within the report. That's what the citizens' rep did, and does regularly. Same goes for the privacy commissioner. And trust me, I always check my facts.

Pam Frampton

April 04, 2011 - 13:16

Jay, I suggest you read my comment again. I said that there is no reason why the minister couldn't release the results/general gist/recommendations of the peer review once it has been completed, without violating anyone's privacy. Just as the citizens' rep and the privacy commissioner release reports without divulging personal information, so too could the minister when the time comes. I agree that the minister may not be able to release every shred of information in it, but surely he can commit to making its recommendations public.

Chantal

April 04, 2011 - 09:06

An excellent and thoughtful column, Pam. As for Dr. Craig (the Pen's answer to Dr. Phil?); his approach has been severely criticised by many other professionals in the mental health field. As both a mental health provider and survivor, the idea of denying someone their meds in order to “treat” them is as counter-productive as it is bizarre.

I am unable to stop sobbing and crying. What a bleeding heart approach to those criminals that are just that. I agree that mental health issues should be handled when apparent but please stop telling me about little "Johnny" who steals, robs to shoot drugs up his arm because he was potty trained too early or Daddy didn't love him and made him take out the trash. Please!

Pam,
Your comment about the taking away of medications in a 'Willy Nilly' fashion is ridiculous and destroys any other point you are trying to make here. Dr. Craig is a licensed, skilled, respected physician and psychiatrist. He is not one to do anything 'Willy Nilly' in his professional life.
That's the basic problem here. Dr. Craig is offering the second opinion you seek and because it does not involve keeping the inmate hopped up on meds, they are protesting. You are actually seeking a third opinion for inmates.
Perhaps an article on the two way nature of medical treatment would be more appropriate. The responsibility in rehabilitation and personal well being lies with the patient as well as the Dr. When the patients honestly want to get better and take their treatment seriously then the Dr. will have a person they can actually work with and achieve success with. When the motivation for treatment is not the same, then we often get the unfortunate results they achieve on outside of prison; a trip inside the prison.